How Often Should Elderly People Strength Train?

Zachary Walston

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One of the most important markers of health as people age is their strength. Studies have shown quadriceps and grip strength are directly related to all-cause mortality. While strength can be improved without adding more muscle to your body, the amount of muscle you have raises the floor and ceiling of strength potential.

Think about some of the fundamental movements of life and how strength is vital for them:

  • Getting up off of the floor (gardening, playing with kids, after a fall)
  • Sitting down and standing up from a low seat or toilet
  • Lifting and carrying groceries or household objects
  • Ascending and descending stairs

Muscle is just important for facilitating strength and functional tasks. Muscle is directly responsible for glucose control and our metabolism.

So, if we want to maximize muscle hypertrophy (the term you will find in research studies), what should training volume in the gym look like? Yes, building muscle is hard work and requires resistance exercise. There are many effective ways to perform resistance exercise — calisthenics, powerlifting and weightlifting with barbells, bodybuilding routines with dumbbells and pulleys — but the body has to be pushed.

Despite the plethora of options, findings the right exercise does is challenging.

Optimal vs. minimal dose for building muscle

Most studies simply compare two protocols, such as 6 sets of leg extensions per week compared to 12 sets, which doesn’t tell us the best program to build quadriceps muscle and strength for an individual. This also highlights an issue with the term ‘non-responder.’

A ‘non-responder’ is someone who does improve in an expected manner. They are the ‘hard gainers’ who can’t seem to put on muscle no matter how hard they train or how much they eat. This term is fraught with pitfalls as it is based on statistics and limited information.

Every person is unique and many variables influence our responses to training — diet, sleep, stress, training history, genetics, exercise duration, exercise intensity, time of day, recovery strategies — and to label someone as a ‘non-responder’ because they didn’t improve with a specific protocol is lazy research.

Perhaps the participants did not eat or sleep enough to support hypertrophy. Perhaps they needed to perform a little more volume or intensity, like this study that showed two additional weeks shifted people from ‘non-responder’ to ‘responder.’

These same issues apply when trying to determine widespread recommendations, whether they be for optimal or minimal doses of exercise.

That didn’t stop the authors of a recent research opinion article from trying.

Age is just a number

As this study is an opinion piece, not original research, it will be a biased snapshot of the research, so keep that in mind when I share the authors’ findings. The article was published on September 30th and it’s the authors’ attempt to answer a research question using a literature review.

It is not a systematic review or meta-analysis, meaning this research is at the bottom of the evidence hierarchy. It still provides value, however, particularly when you look at the individual studies they site.

The authors wanted to know the best exercise strategies for building muscle and strength in older adults. The first question that needs to be asked, however, is whether elderly individuals are capable of building muscle.

The research says they can.

Regardless of age, building muscle and strength is possible, but blunted compared to young and middle-aged adults. This study — a systematic review — shows very elderly adults (>75 years old) can increase their muscle strength and size through resistance training. These effects were observed with resistance training interventions that generally included low weekly training volumes and frequencies. For strength, the interventions lasted from 8 to 18 weeks with a training frequency of 1 to 3 days per week. For hypertrophy (building muscle), the interventions lasted 10 to 18 weeks, with a training frequency of 2–3 days per week.

This is great news as previous research suggests quad strength is a primary predictor of mortality. Another study showed hip flexor strength was the primary determinant in the progression of functional capacity decline.

So, we have established building strength and muscle is both important and possible in the elderly. Back to the original question:

Which strategies are optimal?

Basing volume on weekly sets

There isn’t a magic muscle-building rep zone, as research shows there are many ways to build muscle, but volume does need to be considered. We need to reach a certain threshold of intensity (preferably at least 30% of your 1 rep max for an exercise), but overall, volume is king.

How should volume be measured?

Training volume is traditionally determined by multiplying the number of sets, repetitions, and load. As the amount of load directly influences the number of repetitions performed, the number of sets performed plays an independent role during the strength training progression management and training volume measurement. Total sets are a better predictor of hypertrophy than contraction type (e.g. eccentric vs. concentric). The challenge is determining the minimum dose to stimulate hypertrophy and the optimal dose to maximize hypertrophy.

Back to the opinion piece.

The authors chose weekly sets of exercises as their marker for volume. This precedent has been set as many studies use weekly sets as a marker for determining training volume. Keep in mind, the weekly sets, or within-session sets, are often specific to a muscle group, such as the quadriceps.

Some research suggests 10 weekly sets per muscle group may be the minimum number to maximize hypertrophy, with the number increasing depending on training history. Too many sets can be detrimental, with one study showing more ultrasound muscle damage after 15 weekly sets per muscle group compared to 9. The upper threshold has not been explored often. As mentioned, this is challenging as all people are unique (training history, lifestyle, genetics, psychosocial influences, etc.) So, instead of optimal dose, the minimum dose is often easier to explore.

I don’t think an optimal dose can ever be determined on a population level. Even the minimum dose won’t apply to everyone, as we see with the ‘non-responder’ studies. How can you apply this information?

The 10 weekly sets can be thought of as the starting point. You need to perform some trial and error and personalize your program. Answer these questions:

  • How many sessions can you commit to in a week?
  • How long can you train each session?
  • Are you recovering appropriately? (rest days, adequate sleep, good diet, low stress)
  • Are you training hard in your sessions? (approaching failure in your lifts)

If you aren’t seeing results, something needs to change. If. you are always exhausted or getting hurt, back off the training or improve the recovery strategies. If you need additional guidance, reach out to a credible source (not an instaguru who peddles misinformation and a “superior” program only they have.”

The take-home message is this: elderly people can build muscle but there is no universal way of doing it.

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I am a physical therapist, researcher, and educator whose mission is to challenge health misinformation. You will find articles about health, fitness, medical care, psychology, and professional development on my site. As the husband of a real estate agent, you will also find real estate and housing tips.

Atlanta, GA
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